Comparison of revised trauma score with MGAP score in determining clinical outcomes of multiple trauma patients hospitalized in trauma center

Document Type : Original Article


1 Asossiat Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

2 Associate Professor, Department of Biostatistics, Social Determinants of Health Research Center, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

3 MSc in ICU Nursing, Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences Rasht, Iran

4 Assistant Professor, Neuroscience Research Center, School of Nursing and Midwifery, Guilan University of Medical Sciences Rasht, Iran


Background: Trauma is one of the important causes of disability, death and major health problem in the world. Various instruments are used to assess the clinical outcomes of trauma patients.
Objectives: The aim of this study was to compare the Revised Trauma Score (RTS) with the MGAP score in determining the clinical outcomes.
Methods: A retrospective cross-sectional analytical study was conducted on 1000 multiple trauma patients admitted to Poursina Hospital in Rasht. The data collection instruments included a three-part checklist of demographic and clinical characteristics, RTS and MGAP scores, and clinical outcomes (length of hospitalization and mortality). Data were analyzed using descriptive and non-parametric statistical tests by SPSS 21 software. To determine the predictive power of RTS and MGAP mortality using the ROC test, in addition to obtaining the area under the curve (AUC), the cut-off point, sensitivity, specificity, positive and negative predictive values (PPV and NPV) were obtained.
Results: The findings showed that 3% of patients (CI: 95%) died and the length of hospitalization was 3.7±2 days. The mortality prediction level of RTS and MGAP instruments for trauma patients was significant (P<0.001) according to AUCs of 97.9% and 98.3%, respectively. Correlation between MGAP and RTS for the length of hospitalization were significant (r=-0.267and r=-0.274, p<0.001), but the intensity of correlation between MGAP and RTS was not significant. The best cut-off points for RTS and MGAP were equal to 7 and 22.5, respectively, with sensitivity rates of 98.1% and 92.3%., specificity rates of 96.7%, and 92.3%., PPV values of 97.7% and 92.3% and NPV values of 92.3% and 98.1%, respectively.
Conclusion: MAGP and RTS instruments can predict the clinical outcomes of trauma patients well, but they did not have a significant superiority over each other. Therefore, the preferred choice of one of these agents requires multicenter studies.


  1. Norouzi V, Feizi I, Vatankhah S, Pourshaikhian M. Calculation of the probability of survival for trauma patients based on trauma score and the injury severity score model in fatemi hospital in ardabil. Arch Trauma Res. 2013;2(1):30. doi:10.5812/atr.9411 PMid:24396787 PMCid:PMC3876517
  2. Aoki M, Abe T, Saitoh D, Oshima K. Epidemiology, patterns of treatment, and mortality of pediatric trauma patients in japan. Sci Rep. 2019;9(1):917 doi:10.1038/s41598-018-37579-3 PMid:30696939 PMCid:PMC6351578
  3. Azami-Aghdash S, Sadeghi-Bazargani H, Shabaninejad H, Gorji HA. Injury epidemiology in iran: A systematic review. J Inj Violence Res. 2017;9(1):27. doi:10.19082/3630 PMid:28243417 PMCid:PMC5308505
  4. Mohtasham Amiri Z, Haghdoost Z, Mohseni M, Asadi P, Kazemnezhad Leili E. Patients discharged before and after presence of medical emergency specialists. J Holistic Nurs Midwifery. 2014;24(1):64-70.
  5. Mohseni M, Khaleghdoost Mt, Kazemnejed Le, Adib M. Epidemiologic survey of trauma and associated factors in guilan. 2014.
  6. Ahmadi K, Taleshi Z, Jokar A, Pouryaghub M, Bayaat F, HajiMaghsoudi L, et al. Effect of advanced trauma life support (atls) program on nurseś performance in simulated trauma model. Alborz Univ Med J. 2017;6(3):173-8. doi:10.18869/acadpub.aums.6.3.173
  7. Soni KD, Mahindrakar S, Gupta A, Kumar S, Sagar S, Jhakal A. Comparison of iss, niss, and rts score as predictor of mortality in pediatric fall. Burns Trauma. 2017;5. doi:10.1186/s41038-017-0087-7 PMid:28795055 PMCid:PMC5547492
  8. Ahun E, Köksal Ö, Sığırlı D, Torun G, Dönmez SS, Armağan E. Value of the glasgow coma scale, age, and arterial blood pressure (gap) score for predicting the mortality of major trauma patients presenting to the emergency department. Turk J Trauma Emerg Surg. 2014;20(4):241-7. doi:10.5505/tjtes.2014.76399 PMid:25135017
  9. Brod B, Patel T, Hargett R, Lebrun B, Ahmed S, Branly R, et al. Hypoxic brain trauma causing blindness in a multiple gunshot wound patient: a challenging clinical scenario with a brief review of the literature. Novel Clin Med. 2024; 3(1): 50-57. doi: 10.22034/ncm.2023.408036.1102
  10. Bouzat P, Legrand R, Gillois P, Ageron F-X, Brun J, Savary D, et al. Prediction of intra-hospital mortality after severe trauma: Which pre-hospital score is the most accurate? Injury. 2016; 47 (1): 14-8. doi:10.1016/j.injury.2015.10.035 PMid:26549667
  11. Roden-Foreman JW, Rapier NR, Foreman ML, Zagel AL, Sexton KW, Beck WC, et al. Rethinking the definition of major trauma: The need for trauma intervention outperforms injury severity score and revised trauma score in 38 adult and pediatric trauma centers. J Trauma Acute Care Surg. 2019;87(3):658-65. doi:10.1097/TA.0000000000002402 PMid:31205214
  12. Kim SC, Kim DH, Kim TY, Kang C, Lee SH, Jeong JH, et al. The revised trauma score plus serum albumin level improves the prediction of mortality in trauma patients. Am J Emerg Med. 2017; 35 (12):1882-6. doi:10.1016/j.ajem.2017.06.027 PMid:28637583
  13. Madni TD, Ekeh AP, Brakenridge SC, Brasel KJ, Joseph B, Inaba K, et al. A comparison of prognosis calculators for geriatric trauma: A prognostic assessment of life and limitations after trauma in the elderly consortium study. J Trauma Acute Care Surg. 2017;83(1):90-6. doi:10.1097/TA.0000000000001506 PMid:28422904
  14. Soltani Y, Khaleghdoost Mohamadi T, Adib M, Kazemnejad E, Aghaei I, Ghanbari A. Comparing the predictive ability for mortality rates by gap and mgap scoring systems in multiple-trauma patients. J Mazandaran Univ Med Sci. 2018;27 (157): 118-32.
  15. Galvagno SM, Massey M, Bouzat P, Vesselinov R, Levy MJ, Millin MG, et al. Correlation between the revised trauma score and injury severity score: Implications for prehospital trauma triage. Prehosp Emerg Care. 2019;23(2):263-70. doi:10.1080/10903127.2018.1489019 PMid:30118369
  16. Khayat NH, Poor HS, Rezaei MA, Mohammadinia N, Darban F. Correlation of revised trauma score with mortality rate of traumatic patients within the first 24 hours of hospitalization. Zahedan J Res Med Sci. 2014;16(11):33-6.
  17. Lestari Putri TIY, Widasmara D. Revised trauma score (RTS) as outcome predictor of head injury patients. Indian J Public Health Res Dev. 2020;11(1). doi:10.37506/v11/i1/2020/ijphrd/194073
  18. Tirtayasa PM, Philippi B. Prediction of mortality rate of trauma patients in emergency room at cipto mangunkusumo hospital by several scoring systems. Med J Indonesia. 2013;22(4):227-31. doi:10.13181/mji.v22i4.603
  19. Selim M, Marei A, Farghaly N, Farhoud A. Accuracy of mechanism, glasgow coma scale, age and arterial pressure (MGAP) score in predicting mortality in polytrauma patients. Biolife. 2015; 3(2):489-95.
  20. Hasler RM, Mealing N, Rothen H-U, Coslovsky M, Lecky F, Jüni P. Validation and reclassification of MGAP and GAP in hospital settings using data from the trauma audit and research network. J Trauma Acute Care Surg. 2014;77(5):757-63. doi:10.1097/TA.0000000000000452 PMid:25494429
  21. Gilpin D, Nelson P. Revised trauma score: A triage tool in the accident and emergency department. Injury. 1991;22(1):35-7. doi:10.1016/0020-1383(91)90158-B PMid:2030028
  22. Jeong JH, Park YJ, Kim DH, Kim TY, Kang C, Lee SH, et al. The new trauma score (nts): A modification of the revised trauma score for better trauma mortality prediction. BMC Surg. 2017;17:1-9. doi:10.1186/s12893-017-0272-4 PMid:28673278 PMCid:PMC5496419
  23. Mohammed Z, Saleh Y, AbdelSalam EM, Mohammed NB, El-Bana E, Hirshon JM. Evaluation of the revised trauma score, mgap, and gap scoring systems in predicting mortality of adult trauma patients in a low-resource setting. BMC Emerg Med. 2022;22(1):1-10. doi:10.1186/s12873-022-00653-1 PMid:35643425 PMCid:PMC9148470
  24. Rahmani F, Ebrahimi Bakhtavar H, Shams Vahdati S, Hosseini M, Mehdizadeh Esfanjani R. Evaluation of mgap and gap trauma scores to predict prognosis of multiple-trauma patients. Trauma Mon. 2017;22(3). doi:10.5812/traumamon.33249
  25. Baghi I, Shokrgozar L, Herfatkar MR, Ehsan KN, Amiri ZM. Mechanism of injury, glasgow coma scale, age, and systolic blood pressure: A new trauma scoring system to predict mortality in trauma patients. Trauma Mon. 2015;20(3). doi:10.5812/traumamon.24473
  26. Sartorius D, Le Manach Y, David J-S, Rancurel E, Smail N, Thicoïpé M, et al. Mechanism, glasgow coma scale, age, and arterial pressure (mgap): A new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010; 38 (3):831-7. doi:10.1097/CCM.0b013e3181cc4a67 PMid:20068467
  27. Huang Y-T, Huang Y-H, Hsieh C-H, Li C-J, Chiu IM. Comparison of injury severity score, glasgow coma scale, and revised trauma score in predicting the mortality and prolonged icu stay of traumatic young children: A cross-sectional retrospective study. Emerg Med Int. 2019;2019:5453624. doi:10.1155/2019/5453624 PMid:31885926 PMCid:PMC6914995